6. Disability, Basic Health and Welfare
Relevant UNCRC Articles: 6, 18(3), 23, 24, 26, 27(1-3) and 33
This cluster group focuses on the health and welfare of all children and young people and the consideration of the rights of disabled children.
Disability and Basic Health
6.1 Support for Disabled Children and Young People
“The views and opinions of young people with disabilities should be heard, they should be included in all decision making processes affecting them…”
Article 12 in Scotland, I Witness: The Concluding Observations, 2018, p.12
In December 2016 the Scottish Government launched, A Fairer Scotland for Disabled People: Our Delivery Plan to 2021 for the United Nations Convention on the Rights of Persons with Disabilities. This Action Plan set out the Scottish Government’s overarching ambition to transform the lives of disabled people in Scotland, following over two years of detailed discussion, negotiation and co-production. The Plan is centred on five long-term ambitions and a set of 93 actions. Many of these actions will impact on individuals of all ages, whilst a number are specifically targeted at children and young people.
Young Disabled People’s Forum
The Scottish Government recognises that effective solutions to the problems and barriers faced by disabled people must be drawn from the lived experience of disabled people. The Young Disabled People’s Forum, Youth Action Success, supports Scottish Government policy officials to understand the challenges faced by disabled young people. This group of 25 young people, with a wide range of disabilities, help to shape and inform policy. The Forum meets up to 4 times per year to discuss various themes and topics which may be submitted by policy areas but are selected by the young people themselves. The work of the Forum is overseen by the Disabled Children and Young People Advisory Group.
Supporting Disabled Children, Young People and their Families Resource/Website
Scottish Ministers are committed to ensuring that all children and young people can achieve their full potential. The Scottish Government is in the final stages of developing an information resource to support disabled children, young people and their families. This will provide information, based on the lived experiences of disabled children, young people, and their families across 3 pillars: rights and information; accessibility of support; and transitions. The information will be developed into a website and will also be accessible through mobile devices.
A consultation on the content of the resource closed on 5 September 2018. The 110 responses received will be analysed before a report is produced early in the New Year. An engagement event tour of Scotland took in 11 areas of Scotland. Presentations on the content, along with rich and useful discussions during the consultation period, helped reinforce the need for the resource as well as highlighting potential gaps.
Additional content will be added to the resource taking account of the views of respondents to the consultation and those who attended the engagement events. This will help to ensure that the resource is a valuable and relevant information tool for young disabled people and their families/caregivers. The development of the final content of the resource will involve parent groups and the Youth Action Success Forum.
The Family Fund Trust is the UK’s largest grant-giving charity for disabled children. Grant funding from the Scottish Government allows the Family Fund to provide support for low income families raising disabled or seriously ill children and young people. This funding is based on what families themselves decide will make the greatest impact on their circumstances and wellbeing. Support from the Family Fund for the Short Breaks Fund is discussed at section 5.7.
Learning Disabilities and Autism
The Scottish Government remains committed to transforming the lives of autistic people and those with learning disabilities, including children and young people, and aims to specifically address the inequalities they face in accessing health, education, work and active participation in society. The Scottish Strategy for Autism was refreshed in 2018 to focus on specific priorities for the next 3 years. The Keys to Life, learning disabilities strategy refresh will be published in February 2019. The refreshed priorities will help achieve the 4 strategic outcomes intended to ensure people with autism and learning disabilities live healthier lives, have choices and control over the services they use, and are supported to be independent and active citizens.
By aligning these aims with the wider ambitions for the A Fairer Scotland for Disabled People: Delivery Plan, the Scottish Government hopes to ensure that people feel valued, included and accepted by society. Both strategies are jointly endorsed by the Convention of Scottish Local Authorities (COSLA) and are being implemented through local partnerships of statutory and third sector organisations.
Support for children and young people with disabilities in education is discussed in Chapter 7 of this document.
The Scottish Government is also committed to improving the services, support and care available to people who have sight loss, deafness and dual sensory loss. The long-term strategy, See Hear (2014) commits to ensuring that children, young people and adults have the same access to opportunities and public services as everyone else. The strategy was also jointly endorsed by COSLA and is being implemented through local partnerships.
The Scottish Government’s first British Sign Language National Plan 2017-2023 means that
D/deaf and Deafblind British Sign Language (BSL) users will be fully involved in daily and public life in Scotland and will be able to make informed choices about every aspect of their lives. The Scottish Government has also commissioned and funded contactScotland-BSL, the UK’s first publicly funded online BSL video relay service, which enables Deaf BSL users to contact public and voluntary services, and for these services to contact them. A number of organisations in Scotland have already signed up to use the service, including NHS Scotland and the Scottish Children’s Reporter Administration.
Communication Equipment and Support
Communication equipment and associated support is frequently referred to as Augmentative and Alternative Communication (AAC). The Scottish Government is committed to improving the lives of people who use and need Augmentative and Alternative Communication (AAC).
The Scottish Government recognises that being able to communicate and having freedom of expression is a basic human right – one which is essential to physical and mental health, social wellbeing and is necessary to ensure an equal opportunity to fully participate in communities. This is why the Scottish Government introduced legislation – Communication Equipment and Support in using that Equipment – Part 4 of the Health (Tobacco, Nicotine and Care) (Scotland) Act 2016, which requires that communication equipment, as well as the support to use it, is provided to people of all ages, from all care groups, who cannot speak or who have difficulty speaking.
To support the delivery of the legislation, the following tools have been developed:
- Guidance on the Provision of Communication Equipment and Support in Using that Equipment;
- Easy Read Version of the Guidance; and
- A national AAC Core Pathway.
Work is now underway to co-produce, with National AAC Advisory group members and stakeholders, a refresh of the national AAC high level work plan, reflecting the broader and ongoing program of work on AAC.
Access to Transport, Culture and Sport
The connectivity that public transport provides is a key enabler for disabled children and young people, and their families, to live a life of freedom and equal opportunity. The Scottish Government is aware that disabled children and young people may face particular barriers on the transport network, and equality of accessibility to the network is one of the key themes of the ongoing review of the National Transport Strategy.
Going Further: Scotland’s Accessible Travel Framework (2016) was co-produced with disabled people, disability organisations, transport operators, and government to push forward improvement. The Framework aims to support those involved in transport to understand how to provide an excellent customer service to disabled people across the range of impairments, including those with hidden disabilities. The Scottish Government is ramping up implementation of the Framework by moving to an annual framework delivery programme for this and future financial years. This will build on work in the Scottish Government to improve accessibility for all. Examples of work in this area include a proposal to prohibit pavement parking in the Transport (Scotland) Bill, delivering new infrastructure with accessibility features built in, and improving existing infrastructure like making more railway stations step-free. This work serves to realise the Framework vision that disabled people can travel with the same freedom, choice and dignity as non-disabled citizens.
The Scottish Government has continued to reform the blue badge scheme. For example, it expanded the eligibility criteria in December 2017 to include those children who, as a result of their disability, may pose a risk to themselves or others in traffic where other strategies don’t work to control the risk. Work is ongoing to extend the concessionary travel scheme to provide bus passes for travel companions of eligible disabled children aged under 5.
VisitScotland, the national tourism agency, has also been striving in recent years to make visitor and tourism facilities across the country more inclusive – be that for holidays, short breaks, or simply day trips in the local area. It has also launched a revamped Accessibility Guide online tool, which helps any business in the tourism industry to develop a clear concise accessibility guide of their venue and service. In addition, the Scottish Government has committed to improving physical and online access to Scotland’s historic environment and collections by 2019.
Both the A Fairer Scotland Disability Action Plan and the Curriculum for Excellence make reference to the importance of removing barriers for disabled children and young people to participate in sport activities at school and in the community. Scottish Disability Sport (SDS), in conjunction with Home Country Disability Organisations, has developed a UK Disability Inclusion Training (UKDIT) course, aimed at those interested in becoming involved in sport for people with a disability. SDS is also working with organisations across Scotland to improve access to sporting facilities for all disabled people to develop opportunities and improve performance in disability sport in Scotland. The aim is to ensure that any child, young person or adult with a disability can participate in sport and physical activity regardless of their ability, geography or age.
sportscotland’s investment supports sport-specific activity for participants with disabilities. For example, the redeveloped sportscotland National Sports Training Centre in Inverclyde was opened in August 2017 by the First Minister. This followed £12m of investment by sportscotland. The building is the first of its kind in the UK, providing a residential sports training centre designed with inclusivity in mind for disability sport users, including both performance and community users. This will ensure Scotland is even better placed to support disabled athletes in their preparations and help to ensure sport-specific activity is accessible.
The Scottish Ministers intend to provide the right support at the right time for disabled young people transitioning from children’s to adult services. The Scottish Government funded the Health and Social Care Alliance Scotland, to produce a report: ‘Experiences of Transitions to Adult Years and Adult Services (2017)’, which explores the transitions experiences of disabled young people and their families, with the aim of making a practical difference to improving transitions, using information, themes and solutions gathered from people who have lived experiences of transition. The Report made a number of recommendations which are intended to support practitioners and managers in their practices, services and strategic developments.
The Scottish Government also provides funding to the Association for Real Change Scotland (ARC), which has developed a series of principles, known as the Principles of Good Transitions. In July 2017, ARC published the report, Facing the Future Together, a national survey of young people with additional support needs and their parents and carers about their experiences of leaving school. These provide a basis to inform, structure and encourage the continual improvement of professional support for young people with additional needs between the ages of 14 and 25 who are making the transition into young adult life. The content of each principle has been predominantly informed by the work of the Scottish Transitions Forum, alongside relevant national legislative and policy developments and the UNCRC.
The Scottish Government established the £5m Independent Living Fund Transitions Grant from December 2017 to support disabled young people in transitions (aged 16-21) to live independently and contribute to their communities. Short-term grants allow young people to explore, plan and achieve outcomes that they have identified themselves and for which other sources of support are not available. Disabled young people were involved directly in the development of the Fund. ARC is helping to promote the scheme across Scotland.
Child Disability Living Allowance
Child Disability Living Allowance (DLA) is an ill health and disability benefit which currently provides financial support to children under the age of 16. The benefit is split into a Care component, which relates to the level of looking after which a child requires, and a Mobility component, which relates to the help a child needs in getting around. Either or both can be awarded, depending on the child’s needs.
At age 16, the current Department for Work and Pensions (DWP) process requires children to transition from Child DLA to Personal Independence Payment (PIP). Children with disabilities, and their families, can experience numerous issues during the transitional period between child and adult services at ages 15, 16 and 17. That is why, when the Scottish Government begins to administer Child DLA in Scotland, it has committed to continuing to pay eligible recipients up to the age of 18, to allow for continuity for families during this testing time. Additional information about the financial support that is available to families more generally is discussed at sections 6.21-6.22.
Further and Higher Education
Where young people choose to attend further or higher education, it is important that they receive the support they need while in college or university and to make the transition successfully. There are a number of measures in place to widen access to further and higher education. Work is in hand through the Scottish Funding Council and with other partners to support young people with disabilities in both college and university. For example, improving the 15-24 learning journey; reviewing the Further and Higher Education student support package; working to place student mental health and wellbeing as key priorities for colleges and universities; and delivery of the (non-income assessed) Additional Support Needs for Learning Allowance.
All colleges and universities have a duty under the Equality Act 2010 to make reasonable adjustments to ensure that students with disabilities which affect their studies are not placed at a disadvantage. This duty requires education providers to continually review and anticipate the general needs of disabled people, rather than simply waiting until an individual requests a particular adjustment.
The Scottish Government is committed to better enabling disabled people of all ages to participate in the workforce. One of the desired outcomes of the Developing the Young Workforce: Scotland’s Youth Employment Strategy is to increase the employment rate for young disabled people to the population average by 2021. The 5 year, Equalities Action Plan for Apprenticeships in Scotland, includes specific improvement targets for Modern Apprenticeship (MA) participation by disabled people, including part-time and flexible engagement, also to be achieved by 2021. This provides young disabled people with the highest level of MA funding until the age of 30.
As part of the Scottish Government’s commitment to prepare and support disadvantaged young people into and during employment, funding is provided to the Scottish Council for Voluntary Organisations (SCVO) to deliver the Community Jobs Scotland programme (CJS). CJS provides support and job training opportunities for unemployed young people aged 16-29 who face additional barriers to employment and confirms the Scottish Government’s commitment to working with the third sector to provide that support.
In addition, in April 2017, using newly devolved powers, the Scottish Government put in place transitional services that focused on helping disabled people and those with long-term health conditions find work in a manner not driven by the threat of benefit sanctions. From April 2018, the Scottish Government introduced Fair Start Scotland, a distinctly Scottish employment support service which has a focus on helping people with disabilities and those most disadvantaged in the labour market to move into and sustain fair work.
The Scottish Government recognises that better integration and alignment of employability with other services is a vital part of its ambition to tackle labour market inequalities and help more people into work. In March 2018, it published ‘No One Left Behind – Next Steps for the Integration and Alignment of Employability Support in Scotland’ which contains a comprehensive range of activities to deliver more effective and joined-up employability support across Scotland.
In December 2018, the Scottish Government published A Fairer Scotland for Disabled People: Employment Action Plan in response to the commitment in A Fairer Scotland for Disabled People, published in December 2016. In this, the Scottish Government committed to seek to reduce at least by half, the disability employment gap. The Action Plan includes initial steps towards this ambition with actions to support young people in transitions, to address the barriers faced by disabled people accessing work and to support employers to recruit and retain disabled people.
6.2 Health and Wellbeing in Early Years
The Scottish Ministers are determined that all children should have the best start in life and have taken forward a number of initiatives to promote and support health and wellbeing during the early years, including appropriate antenatal care and advice for mothers.
5 Year Plan to Improve Maternity and Neonatal Care
The Scottish Government is improving maternity and neonatal services in Scotland to ensure that they provide the right care for every woman and baby. In 2015, these services underwent a national review, resulting in the publication of The Best Start: a five-year forward plan for maternity and neonatal care in Scotland (2017). The Best Start sets out the vision for the delivery of high quality and safe maternity and neonatal services across Scotland where services regard mother and baby as one entity and truly put the mother, baby and family at the centre of service planning delivery.
A key recommendation of The Best Start is that all women receive continuity of carer throughout their pregnancy. Midwifery continuity of carer models have proven benefits in terms of improved outcomes for women and babies as well as establishing strong, effective relationships. Neonatal services will also be redesigned to put family-centred care at its heart. This includes the fundamental principles of keeping mother and baby together, positioning parents as partners in decision making around the baby’s care and the parents providing as much care as possible for their baby.
New Family Fund – for Families of Premature Babies.
From 2018-19, the Scottish Government established the £1.5m Family Fund to enable the parents of premature babies in NHS care to receive extra support with the financial cost, such as travel to and from hospital or food and drink. Around 4,400 babies are born prematurely (under 36 weeks) every year in Scotland and estimates show the average additional cost to parents is over £200 a week. The Scottish Government worked with Bliss and NHS Boards to ensure that the process for claiming is simple and clear to all eligible parents. Support from the Fund is available to parents regardless of income.
Fetal Alcohol Spectrum Disorder (FASD)
The Scottish Government continues to prioritise work around FASD, in particular by raising awareness of the condition. FASD is the leading known preventable cause of permanent learning disability worldwide and is caused by maternal use of alcohol during pregnancy. FASD is a devastating condition that can cause lifelong, permanent and irreversible damage.
In July 2017, the Scottish Government launched the FASD Care Pathway, an eLearning resource for health professionals, which aims to help clinicians make a diagnosis as early as possible to provide support, and advise parents and carers how to seek help for their child. A Scottish Intercollegiate Guidelines Network (SIGN) Guideline on the diagnosis of FASD in children is being developed and this is due to report by early 2019. In addition, Ministers announced in the PfG 2018-19 that over the next year, the Scottish Government will work to set up a third sector hub that will focus on both preventing instances of FASD arising in the first place and supporting families following diagnosis.
Healthy Start Scheme
Access to appropriate vitamins and food is important for pregnant women and children pre-birth and in the early years. From April 2017, all pregnant women in Scotland are offered free vitamins, including the new recommended dose of Vitamin D, throughout their pregnancy. This universal access is based on the strong evidence that taking vitamins during pregnancy improves the health of both the mother and her baby.
Powers over Welfare Foods, which includes the Healthy Start and Nursery Milk Schemes, were devolved to Scotland through provisions in the Scotland Act 2016. The Healthy Start Scheme entitles low-income pregnant women and families with young children to receive vouchers for certain foods and vitamins. The Scottish Government aims to use its new Welfare Foods powers to build a more cohesive package of nutrition for children in their early years (section 6.8 refers).
6.3 Baby Boxes
From 15 August 2017, all newborn babies in Scotland are entitled to receive a Baby Box of essential items to support parents and promote a fair and equal start for all children. The box, which has been awarded British Safety Standard accreditation as a crib for domestic use, also provides a safe and comfortable place for babies to sleep near their parents, promoting bonding and early attachment.
The registration process for Scotland’s Baby Box offers health professionals the opportunity to engage with parents at timely intervals throughout pregnancy and to encourage the small number of expectant mothers who do not currently register for antenatal services to do so. The Baby Box also provides health professionals with a timely opportunity to introduce expectant parents to a wide range of health promotion information such as adopting healthy eating and lifestyle habits, smoking cessation as well as ‘no alcohol’ messaging.
During its first year, Scotland’s Baby Box was gifted to 52,065 newborns, with 85% of expectant parents taking up the opportunity to receive the Box. A parent survey in December 2017 demonstrated high levels of satisfaction in relation to the quality, presentation and range of contents of the box.
In August 2018, the Scottish Government, in partnership with Children in Scotland and Young Scot, invited young people across Scotland with a passion for art and design to submit their ideas for the next design of the Baby Box. The theme for the designs is children’s rights. The winning design will feature on the Baby Box from 2019.
6.4 Breastfeeding/Infant Nutrition
The Scottish Government is committed to promoting, supporting and maintaining breastfeeding throughout Scotland. Improving Maternal and Infant Nutrition: A Framework for Action (2011), which includes a range of breastfeeding support activities, outlines the measures that should be taken to ensure that every parent is supported to give their baby the very best nutritional start to life. Funding of £2.3m per year is provided to NHS Boards to implement the Framework. The Scottish Government has invested over £15.8m since it was launched.
The Scottish Government continues to support the work of the third sector in promoting and supporting breastfeeding. In 2017-18, over £396,000 was provided to several voluntary organisations and peer support programmes, including funding to support the National Breastfeeding Helpline administered by the Breastfeeding Network.
The Scottish Government also continues to fund a Scottish UNICEF post and part of the accreditation process for the UNICEF UK Baby Friendly Initiative standards in maternity hospitals, for women at home and for families with babies in neonatal units. One hundred per cent of babies born in hospitals in Scotland are born in UNICEF baby friendly accredited hospitals. Scotland has made the most progress in the UK in achieving the UNICEF UK accreditation to the point where:
- one hundred per cent of Scottish Maternity units are fully accredited and the Scottish Government is now providing funding to enable them to progress towards the sustainability standards and the Gold awards. The Scottish Government would expect the majority to have achieved this by March 2021;
- one hundred per cent of Health and Social Care partnerships are accredited;
- five Scottish Universities providing pre-registration Midwifery and Health Visiting education are accredited and the remainder are progressing towards full implementation of the standards. Many of the areas are now working towards the new sustainability standards and Gold award; and
- the two largest Scottish Neonatal Units, the Princess Royal and Queen Elizabeth University Hospital in Glasgow, are fully accredited. Two others have completed stage 2 of the implementation phase of the brand new standard and several other Neonatal Units are ready to progress.
In 2015, the Scottish Government appointed a National Maternal and Infant Nutrition Co‑ordinator to align improvement work across Scotland. The website, www.feedgood.scot, which offers easily accessible information on breastfeeding, along with signposting to other sources of support, was relaunched in June 2016.
The most recent Information Services Division (ISD) statistics, published on 30 October 2018, shows that Scottish breastfeeding rates have increased with more than half of babies born in 2017-18 (51%) being breastfed at their Health Visitor first visit (around 10 days of age) and 36% being exclusively breastfed. The proportion of babies being breastfed at 6-8 weeks of age is 42%, of which 31% were being exclusively breastfed. This now represents the highest percentage of babies being exclusively breastfed at 6-8 weeks since recording began.
To further support this improvement, additional funding of more than £2m has been provided in 2018-19. This additional funding enables NHS Boards and third sector partners to improve the quality of support and breastfeeding experiences of mothers. The investment aims to address the Scottish Government’s commitment through its A Healthier Future: Scotland’s Diet & Healthy Weight Delivery Plan (July 2018), to reduce the drop off in breastfeeding rates at the 6-8 week point by 10% by 2025.
Scotland-only Maternal and Infant Nutrition Survey
The Scottish Government published the findings of the first Scotland-only Maternal and Infant Nutrition survey in February 2018. The survey data provided a very current picture of what the breastfeeding and nutrition issues are in Scotland, and captured data not routinely collected elsewhere. This was used by Scottish Government in the development of its Diet and Healthy Weight Delivery Plan (2018) and to assist health services and other organisations to design and implement nutritional advice and support for families.
6.5 Health Visitors and Health Reviews
The refreshed Universal Health Visiting Pathway in Scotland (October 2015) presents a core home visiting programme to be offered to all families by health visitors as a minimum standard. This initiative consists of 11 home visits to all families, 3 of which include a formal review of the family and the child’s health by the health visitor. It also provides an opportunity for health visitors, children and their parents to build a strong relationship, in which health visitors can appropriately support families including acting as a gateway to other services. The pathway ensures an increased focus on prevention, early identification and intervention for those children and families suffering or at risk of issues such as domestic abuse, substance misuse and/or effecting mental health and wellbeing. The report Evidence in Support of the Universal Health Visiting Pathway (May 2015) reported significant benefits from this initiative, including mothers having a more relaxed experience of parenting and improvements in the home environment. Full roll-out of the Pathway is expected by 2020.
The Scottish Government’s investment in an additional 500 health visitors by the end of 2018 will ensure that NHS Scotland has the right levels of staff to provide visits and reviews for children in order that they can get the best possible start in life. The Scottish Government is on track to meet this commitment with at least an additional 414.3 WTE Health Visitors in post as at 30th September 2018.
6.6 Support for Young Parents
Although Scotland has seen a significant reduction in levels of pregnancy in young people under 20 years in the last few years, the Scottish Government is not complacent about the support that young people need around pregnancy and parenthood.
The Family Nurse Partnership (FNPs), is an intensive, preventative, one-to-one home visiting programme for first time teenage mothers (as well as some mothers aged up to 24 years) and their children, from early pregnancy until the child reaches 2. The FNP programme aims to improve pregnancy and birth outcomes and break the cycle of disadvantage by working directly with young mothers and their children to improve their health and wellbeing. Family Nurse Partnership is now in 11 health board areas. The Scottish Government has committed to expanding FNP to reach all eligible women (under 19 years of age), in mainland Scotland, by end of 2018.
In March 2016, the Scottish Government published the Pregnancy and Parenthood in Young People Strategy 2016-2026. The Strategy acknowledges that pregnancy and parenthood can be a highly positive experience for some young people, but for others it is associated with an increased risk of a range of poor social, economic and health outcomes. As such, the Strategy sets out evidence informed actions that aim, over 10 years, to support and empower young people to make positive choices about their futures – including pregnancy and parenthood. It also provides extra support for all young parents, particularly those who are looked after, up to the age of 26. The views of young parents have informed both the development of the strategy and its planned implementation.
As part of the implementation of the Strategy, the Scottish Government is working with NHS Health Scotland to develop a guide for professionals working in maternity services, which will provide advice on how to support young parents as they go through their antenatal and post-natal journey.
6.7 Health and Wellbeing Beyond the Early Years
The Scottish Government has taken forward a wide range of measures within the reporting period to improve both physical and mental health outcomes for children and young people. These are discussed below.
Nursing in Schools
School nurses are an important and integral part of the NHS workforce, playing a vital role in supporting children, young people and their families, especially those who are vulnerable. That is why the Scottish Government has refocused their role to work especially with those who most need their support. The Scottish Government has recommended that NHS Boards and Integrated Joint Boards develop teams that enable school nurses, health visitors, community children’s nurses and allied health professionals to work together aiming to improve outcomes and services for Scotland’s children and young people.
Through the PfG 2018-19, the Scottish Government has committed to have an additional 250 school nurses in place by 2022.
Child and Adolescent Health and Wellbeing Action Plan and Framework
The PfG 2017-18 included the commitment to develop a 10-year Child and Adolescent Health and Wellbeing Action Plan to ensure that the Scottish Government’s focus on the needs of children and young people is carried on beyond just the earliest years. In taking this forward, officials have met with a wide range of stakeholders, including children and young people, to seek their views on the content and direction of the Action Plan and further co-production is planned. The Plan will focus on deliverable actions with a strong emphasis on linking together different areas and sectors to achieve change. It will also set out how that change and improvement can be delivered over the 10-year period and what success for each of the actions could look like.
6.8 Child Nutrition
The Scottish Ministers are also continuing to take action to tackle the challenge of poor public health, including the need to increase activity and tackle issues around poor diet and obesity. Poor dietary habits can be established early in life. In 2017, the Scottish Health Survey recorded 72% of children aged 2-15 were of a healthy weight, 13% at risk of being overweight and 13% at risk of being obese.
The Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy Weight (2010) identified early years as one of the four categories for preventative action, an emphasis continued in the Scottish Government’s A Healthier Future: Scotland’s Diet & Healthy Weight Delivery Plan (July 2018), which includes ambitions to halve childhood obesity by 2030 and to significantly reduce diet related health inequalities. The delivery plan also includes measures to support children, young people and their families to achieve a healthy weight.
The Scottish Government is also providing local authorities with funding (£53.918m in
2018-19) to deliver free school meals to all pupils in the first 3 years of primary school at all publicly-funded schools in Scotland. Funding has also been provided to the Scottish Grocers Federation Healthy Living Programme to run Big Breakfast and Healthy Eating Days with local schools for over 10,000 pupils.
In November 2016, the Deputy First Minister asked for a short life technical working group to be convened to undertake a review of the current school food regulations in light of manifesto commitments and the recent changes to Scottish Dietary Goals. The working group provided a report to Scottish Ministers in December 2017 with a set of recommendations designed to move the current school food regulations closer towards the current Scottish Dietary Goals. In June 2018, the Scottish Government launched a public consultation on proposed changes to the school food regulations. The proposed changes include increasing access to fresh fruit and vegetables; introducing lower sugar limits; reducing the availability of sweetened and baked goods in primary schools; limiting the amount of processed meats, etc. The Scottish Government has commissioned research to explore the relationship between the food environment and the planning system, which also considers the food environment in the vicinity of schools. The evidence provided by the research will inform the review of the National Planning Framework for Scotland and Scottish Planning Policy.
Powers over Welfare Foods, which includes the current UK Healthy Start and Nursery Milk Schemes, were devolved to Scotland through provisions in the Scotland Act 2016. As part of the Scottish Government’s drive to give children the best start in life, improve health outcomes and tackle inequality, a consultation document was issued in April 2018 seeking views on how best to take forward these powers to better meet the needs of children and families in Scotland. The Scottish Government’s aim is to develop an effective and proportionate Welfare Foods package that reaches the right children at the right time, makes it easier for families to make healthier choices, improves delivery and makes best use of resources. This includes plans to replace Healthy Start Vouchers with a new Best Start Foods smartcard to help reduce the stigma of using paper vouchers and to increase the weekly payments to cover the costs of ensuring children can receive a healthy and balanced diet from £3.10 to £4.25 a week. The Scottish Government is also seeking to further improve children’s access to a healthy diet by looking at an option of including a healthy snack as part of the Nursery Milk offer.
The Scottish Government is consulting on proposals to restrict the promotion and marketing of targeted food and drink high in fat, sugar or salt to reduce associated health harms. This is a key action outlined in A healthier future: Scotland’s diet and healthy weight delivery plan. The Scottish Government is also continuing to lobby the UK Government, most recently in November 2017, to ban the broadcast advertising of foods high in fat, salt and sugar before the 9pm watershed.
6.9 Promotion of Physical Activity
Alongside diet, physical activity is key to healthy lifestyles for children and young people. The Active Scotland Outcomes Framework (2017) sets out the Scottish Government’s ambitions for a more active Scotland while A More Active Scotland: Scotland’s Physical Activity Delivery Plan (July 2018) outlines the actions that the Scottish Government and a wide range of partner organisations will take to support and enable people in Scotland to be more physically active. This includes actions which particularly target the needs of girls and young women and those children and young people who face barriers to participation.
The Scottish Government is committed to ensuring that sport and physical activity are accessible to all. The Scottish Government’s investment in school sport has seen the number of children completing 2 hours or 2 periods of P.E. a week increase from less than 10% in 2004-05 to 99% in 2018 (99% of primary schools and 94% of secondary schools). This is supported by funding of up to £50m in Active Schools between 2015-19 and a significant investment in facilities over the past 10 years. In 2017 alone, the Scottish Government provided sports governing bodies with an additional £2m to specifically target work on equalities. They also established the £300k Sporting Equality Fund and the Women and Girls in Sport Advisory Board, to drive female participation in sport.
The Government remains committed to providing the right facilities in the right places to cater for performance athletes and local communities alike. For example, 192 Community Sports Hubs are now in place across Scotland. These will increase to 200 by 2020. sportscotland is focusing on establishing and supporting 7 community sports hubs across 5 local authorities in the 5% of the most deprived areas to create more opportunities and explore barriers to participation in these communities.
The Scottish Ministers have set the ambition for Scotland to be the first “Daily Mile” nation with roll-out to nurseries, schools, colleges, universities and workplaces across the country. Every school will be offered help to become a Daily Mile school. Currently, 42% (over 800) of Scottish primary schools are registered as a Daily Mile school, with participation from all local authorities.
6.10 Oral Health
The Scottish Government’s flagship Childsmile Programme has made significant progress in improving the oral health of children in Scotland. Childsmile is delivered by health visitors, oral health teams, staff in nurseries and schools, and dental practices. It concentrates on preventive actions such as supervised toothbrushing instruction and fluoride varnish application.
The progress made by Childsmile in improving oral health can be seen through the results of the National Dental Inspection Programme (NDIP). The NDIP reports annually on the oral health status of primary school children in Scotland, alternating each year between primary 1 and primary 7 children. The most recent NDIP report in 2017 showed that 77% of primary 7 children had ‘no obvious decay experience’ compared with 59% in 2007. Similarly, for P1 children the 2016 report showed that 69% had ‘no obvious decay experience’, compared to 54% in 2006. The success of the Childsmile Programme has also seen marked reductions in fillings and extractions amongst children. Since 2006-07, child fillings have reduced by 35% and child extractions by 16%.
The Scottish Government wants to do more to improve the oral health of children in more disadvantaged communities. In September 2017, under the Fairer Scotland Action Plan, the Scottish Government made additional funding available to ensure that all children in the 20% most deprived areas of Scotland received Childsmile support. The additional staff have been recruited for delivering this programme and the intention is now to begin rolling out the programme to the new areas.
Looking forward, the Scottish Government published the Oral Health Improvement Plan in January 2018. One of the key actions in the Plan, and a new PfG commitment, is to introduce a 3 year Oral Health Community Challenge Fund. The intention is to work with the third sector to support communities to design and lead oral health improvement initiatives for families and their young children.
6.11 Mental Health and Wellbeing
The Scottish Government was the first Government in the UK to have a Ministerial post dedicated to mental health. This reflects the priority which Scottish Ministers give to mental health.
Backed by £150m over 5 years, the Scottish Government’s Mental Health Strategy 2017-2027 (2017), aims to transform mental health provision in Scotland, focusing on themes including: prevention and early intervention; responses in primary care settings; improving the physical health of those with mental health problems; and improving access to mental health services. The Mental Health Strategy also sets out the ambition over 10 years, to achieve parity between mental and physical health, particularly in relation to: equal access to the most effective and safest care and treatment; equal efforts to improve the quality of care; equal status within healthcare education and practice; and equal status in the measurement of health outcomes.
The Scottish Government worked with organisations such as the Scottish Youth Parliament, Children in Scotland and Young Scot to obtain the views of children and young people in policy and service development. The Scottish Government continues to work with children and young people in implementation of the strategy and in developments which effect children, young people and their families. For example, a Youth Commission on Mental Health, facilitated by Young Scot and the Scottish Association for Mental Health (SAMH), is due to report in spring 2019.
In June 2018, the Scottish Government and COSLA announced a taskforce on Children and Young People’s Mental Health, chaired by Dr Dame Denise Coia and backed by an initial £5m. The taskforce will take a whole systems approach, examining all children and young people’s mental health and mental wellbeing services. Dame Denise has talked with children and young people, their families, services, agencies and practitioners and provided initial recommendations to the Scottish Government and COSLA in September 2018. She will share the chair with a Youth Commissioner to keep the voices of children and young people at the centre of this work.
Investment in Mental Health Services
In 2017-18, for the first time, NHS investment in mental health exceeded £1 billion. Over 5 years, the Scottish Government is investing £150m in mental health innovation, including:
- £54.1m to support reductions in waiting times, including £4.6m for Healthcare Improvement Scotland (HIS) to work with Boards facing particular pressures. Through this funding, the Scottish Government aims to offer treatment to an additional 10,000 patients in the first year, an increase of around 25% on current numbers, rising up to 20,000 in 2019-20;
- £10m to support new ways of improving mental health in primary care settings;
- £15m to support better access to CAMHS;
- £1m to support people with mental health problems to become more physically active; and
- £3.4m to support people in distress who turn to frontline services.
“… young people [should] have strong mental health support within educational settings, whether this means implementing improved teacher training or placing mental health professionals within educational environments.”
Emily, MSYP, Rights Review Event, 2018
Children and young people’s mental health is at the heart of the recently published PfG 2018-19, which sets out a £250m package of measures to do more to support positive mental health and prevent ill health, including:
- Counselling – over £60m in additional school counselling services, supporting 350 counsellors. Around £20m for 250 additional school nurses. This will ensure that every high school has a counselling service. Also, there will be 80 additional counsellors in further and higher education;
- mental health first aid – enhancing support and professional learning materials for teachers so every council has access to mental health first aid training for teachers; and
- community support – £65m to develop a community mental wellbeing service for 5-24 year olds, offering immediate access to counselling, self-care advice and family and peer support.
Children and Adolescent Mental Health Services (CAMHS)
The Scottish Government is committed to meeting its target for 90% of those referred for specialist CAMHS starting treatment within 18 weeks, and is continuing to work with NHS Boards to help them to make the necessary improvements. Work on access to CAMHS aims to ensure that services are available, accessible, of a good quality and pay particular attention to vulnerable children and young people – such as those living in poverty, children in care, children in contact with the criminal justice system and children with a learning disability and/or autism.
Children and young people referred to CAMHS will generally be treated in the community. There may however be times when it is necessary to admit children and young people to hospital for specialist treatment. Should this be the case, they would be admitted to one of the 3 regional CAMHS inpatient units. There may be occasions when it may be clinically judged to be more appropriate to admit young people to adult wards or the young person and their family have a preference for an admission to a local adult ward. Most of these admissions would be for young people aged 16 or 17.
For adolescent inpatient beds, the boards collaborate in 3 regions and the Scottish Government provided funding to allow the North of Scotland Region to increase the number of beds available at Dudhope House, Dundee, for children and young people with mental health problems, from 6 beds to 12 beds. The new unit opened in May 2015. The most recent figures from the Scottish Government 2018 Bed Census indicate that there were 51 patients aged under 18 occupying the 54 available CAMHS inpatient beds. In addition, 6 patients under 18 were staying in other wards.
The Scottish Government is working to improve the transitions for young people moving from CAMHS to adult mental health services, including potential flexibility for those aged 18-25 to continue their care and treatment with CAMHS, where appropriate. The Youth Commission is considering this proposal as part of its work and will publish its view in March 2019.
In addition, Transition Care Plans (TCPs) were launched on 29 August 2018. The TCPs have been co-designed by young people and clinicians, with the aim of allowing young people transitioning between CAMHS and adult mental health services to do so in a smooth and straightforward manner. Young people will be able to use these to outline their personal preferences for their own care. Crucially, they will be created, owned and updated by young people themselves. There is also a set of service documents for use by clinicians in both CAMHS and adult services. This includes a draft central transitions protocol for use by referring and receiving teams. The Minister for Mental Health has written out to all health boards and Integration Joint Boards to ask them to implement use of the tool within their organisations.
There are a number of reasons why a referral to CAMHS may be rejected, for example, there may be occasions when another intervention before CAMHS treatments is needed. Ultimately, this is a clinical decision. In June 2018, the Scottish Government published a qualitative and quantitative audit of rejected referrals to CAMHS. The Scottish Association for Mental Health (SAMH) and the Information Services Division (ISD) of NHS National Services Scotland undertook this work, which explored the experiences of children, young people and their families who were referred to CAMHS but who did not subsequently receive their services. The recommendations from this audit are to form part of the work of the Children and Young People’s Mental Health Taskforce.
The challenge presented by isolation is keenly felt by many in Scotland’s rural communities. The National Rural Mental Health Forum has been established to help people in rural areas maintain good mental health and wellbeing. This Forum will help develop connections between communities across rural Scotland so that isolated people can receive support when and where they need it.
Some children travel outwith Scotland to receive specialist care. While it is possible that, in order to provide the appropriate clinical care, some highly specialist services will always need to be provided out of the country where numbers of patients are very small, this should be minimised where possible. In order to reduce the need for vulnerable young people to travel outside Scotland for their health care and to improve the pathways of care, the Scottish Government has offered funding to support the capital development of a forensic CAMHS inpatient unit. Planning proposals are currently with the NHS.
The Scottish Government is also supporting work on potential mental health inpatient needs of children and young people with a learning disability (intellectual disability) and/or an autism spectrum disorder. In this regard, Action 20 of the Mental Health Strategy is to scope the required level of highly specialist in-patient services for young people and act on its findings. This work is ongoing and an options appraisal will be presented to NHS Directors of Planning in December 2018.
CAMHS Eating Disorders
The majority of young people with an eating disorder will be treated in the community by local CAMHS, with a small number being referred on to regional specialist in-patient services. All NHS Boards keep such services under review and are working towards improved access and outcomes for patients. Action 22 in the Mental Health Strategy is to support the development of a digital tool to support young people with eating disorders accessing services in the digital age.
NHS Lothian CAMHS, in partnership with BEAT, the national eating disorders charity, has developed an online platform for parents and carers to support recovery for young people with eating disorders and to provide online peer support for young people under 25 and their parents and carers.
6.12 Support for Children and Young People with Attention Deficit Hyperactive Disorder (ADHD)
As demonstrated by the NHS Information Services Division (ISD) annual prescribing data of psychotropic drugs, including ADHD medication, the number of items prescribed for ADHD has been increasing consistently over the last 10 years, reflecting the continued and substantial increase in demand for CAMHS. All prescribing should be in line with clinical guidelines and evidenced-based practice, following a mental health assessment, and with their use, their potential benefits and side effects carefully explained to children, their parents or other relevant carers.
Drugs for ADHD are often used alongside treatments such as counselling or psychological therapies. The Scottish Government has worked with NHS Education for Scotland to produce, The Matrix (2015) A Guide to Delivering Evidence-Based Psychological Therapies in Scotland, which has a dedicated section on ADHD. The Scottish Government is also investing in innovative approaches to parenting, including the Psychology of Parenting Programme (PoPP), a Scotland-wide plan aimed at improving outcomes for 9,000 high-risk 3 and 4 year-olds who have high levels of behaviour problems. Early results indicate that 80% of children whose parents have participated have shown reductions in behaviour problems.
The Mental Welfare Commission for Scotland is an independent organisation tasked with protecting and promoting the rights of people with mental disorder including children. They provide independent second opinions for treatment under compulsion, including specialist child and adolescent psychiatrists.
6.13 Managed Clinical Network on Perinatal Mental Health
The Scottish Government is also committed to improving the care and attention provided to women with mental health problems, particularly during pregnancy and after the birth of their child. Action 16 of the Mental Health Strategy is to fund the introduction of a Managed Clinical Network (MCN) to improve the recognition and treatment of perinatal mental health problems. The Scottish Government is providing funding of £173k per annum for the MCN on perinatal mental health over the next 3 years. The MCN has started to deliver on its workplan which will include a mapping and gapping exercise of current provision across all levels of service delivery through 2017 and 2018. This work has led to a commitment and investment in the PfG 2018-19 to develop a stronger network of care and support for the 1 in 5 new mothers who experience mental health problems.
6.14 Suicide Prevention
Whilst death by suicide involving children is extremely rare, any suicide is a tragedy. Between 2002-06 and 2013-17, the rate of death by suicide in Scotland fell by 20%. The Scottish Government’s Suicide Prevention Strategy 2013-16 was developed on the basis of the growing evidence base about factors related to death by suicide. Building on progress made since 2013, Scotland’s new Suicide Prevention Action Plan Every Life Matters, published in August 2018, envisages a Scotland where suicide is preventable; where help and support is available to anyone contemplating suicide and to those who have lost a loved one to suicide. The Plan sets out actions which leaders at national, regional and local level must take to transform society’s response and attitudes towards suicide, including the targets to further reduce the suicide rate by 20% by 2022 (from a 2017 baseline) and to consider, in particular, the needs of children and young people.
As set out in Action 1 of the Plan, the National Suicide Prevention Leadership Group has been established and is being chaired by ex-Deputy Chief Constable, Rose Fitzpatrick. The group will publish a delivery plan by the end of 2018, setting out how the actions in the action plan are to be implemented.
6.15 Support for Bereaved Children and Young People
Experience of bereavement of a close family member or other person can be a life-defining experience for a young person. Children and young people who experience multiple bereavements are known to be at particular risk of negative impacts that can last into adulthood. The Scottish Government is committed to appointing a childhood bereavement coordinator to advise on steps that can be taken to drive forward improvements in bereavement services and support for children and young people. Children in Scotland were commissioned to provide a report which will help refine how this can be taken forward to help ensure that the work of the coordinator is engaged with the range of current bereavement services and supports for children and young people across Scotland.
6.16 Social Isolation and Loneliness
In 2015, the Scottish Government welcomed the Scottish Parliament’s Equal Opportunities Committee’s report on social isolation and loneliness, which recommended that a national strategy should be produced to coordinate the approach to tackling this problem across policy areas and organisations. In taking this forward, the Scottish Government consulted on a draft strategy for tackling social isolation and loneliness, including amongst children and young people, in the spring of 2018. The finalised strategy will be published by the end of 2018.
6.17 Sexual and Reproductive Health
The Scottish Government encourages young people to delay sexual activity until they are ready and encourages them to practice safer sex when they do become sexually active. It is essential that anyone who is, or is considering becoming sexually active, has access to guidance and services, which is why the Scottish Government has asked NHS Boards and councils to ensure young people’s sexual health ‘drop-in’ services are available within or near every school in Scotland.
The Scottish Government is also working with NHS Boards and councils to ensure appropriate Relationships, Sexual Health and Parenthood (RSHP) education is delivered in all Scottish schools. Sexual health services based within schools can offer free condoms. Other contraception is not routinely available within school sexual health services and there are no plans to extend contraceptive services in schools. Professionals within school-based services will signpost for access to routine and emergency contraception where appropriate. In line with the ambitions set out in the Sexual Health and Blood Borne Virus Framework 2015-2020 Update, the Scottish Government is continuing to work with health boards to ensure that sexual health services meet the needs of the people of Scotland, including young people and vulnerable groups.
The Scottish Government has continued its work with third sector partners to improve sexual health and reduce transmission of HIV. This includes funding for Waverley Care and their work to engage directly with populations affected by poor sexual health and blood borne viruses (BBVs), using a peer-to-peer approach to gather their views and experiences in order to inform the development and delivery of targeted services that address defined needs, challenge stigma and promote prevention, testing and support. A research manager to support research on BBV and sexual health issues has also been appointed. Pre-Exposure Prophylaxis (PrEP) has been made available in Scotland via NHS Scotland. The Scottish Government has also funded an exploratory study to test STASH, a peer-led intervention to prevent and reduce STI transmission and improve sexual health in secondary schools.
6.18 Drug and Alcohol use
Drug taking levels among young people in Scotland remain low. The 2015 SALSUS survey (Scottish Schools Adolescent Lifestyle and Substance Use Survey) published in October 2016, demonstrated that the majority of pupils (95% of 13 year olds and 81% of 15 year olds) have never used drugs.
The subject matter of the Misuse of Drugs Act 1971 is reserved to the UK Government. The Psychoactive Substances Act 2016, which came into force in May 2016, creates a blanket ban on the production, distribution, sale and supply of psychoactive substances in the United Kingdom.
The 2015 SALSUS survey results on alcohol consumption demonstrate that the proportion of 13 and 15 year-olds who have ever drunk alcohol were at the lowest level since the survey began in 1990 (28% of 13 year-olds and 66% of 15 year-olds). The survey also notes that there has been a significant decrease in the proportion of 15 year-olds who reported drinking alcohol within the last week (dropping from 34% in 2010 to 17% in 2015). Although these statistics are positive and demonstrate progress, the Scottish Government is committed to protecting young people and children from the harmful effects of alcohol. Underage drinking can cause short and long term harm to health, as well as put young people in dangerous situations when drunk.
This is why the Scottish Government has taken steps to limit the access of young people (under the age of 18) to alcohol. Provisions in the Air Weapons and Licensing (Scotland) Act 2015, which came into effect in May 2017, create a new offence for giving, or making available, alcohol to a child or young person for consumption in a public place. In addition, on 15 November 2017, the UK Supreme Court ruled in favour of the Scottish Government’s legislation to set a minimum unit price for the sale of alcohol - a measure that is the most effective and efficient way to tackle the cheap, high strength alcohol that causes so much damage to so many families. Following public consultation, the Scottish Government introduced a 50 pence minimum unit price from 1 May 2018.
The Alcohol Framework Changing Scotland’s Relationship with Alcohol: A Framework for Action (2009), contained over 40 measures which sought to reduce consumption, support families and communities, encourage more positive attitudes and choices and improve treatment and support services. Building on this, an updated Alcohol Framework (2018), published in November 2018, outlines the Scottish Government’s national prevention aims on alcohol including a strong focus on doing more to protect children and young people from alcohol-related harm.
Scotland’s Drug Strategy, The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem (2008) focused on the needs of the individual and recommends a range of evidence-based and person centred interventions. Following on from this, the Alcohol and drug treatment strategy - Rights, respect and recovery (2018), published on 28 November 2018, presents a new combined approach to the treatment of drugs and alcohol in recognition of the many shared underlying causes and similarities in treatment services. It will, therefore, ensure that wider health and social needs are taken into account as part of people’s treatment and support. This also includes support for children, young people and families affected by a loved one’s drug or alcohol use. The implementation of the Strategy will be supported by the PfG 2017-18 commitment to invest a further £20m in alcohol and drug services.
In 2017, the Scottish Government collected information on the drug and alcohol education and prevention being delivered in Scotland. Taking preventative measures remains crucial to the Scottish Government’s approach and aim to reduce problematic alcohol and drug use as well as the harm emanating from these.
Investment in measures to tackle problem alcohol and drug use
The Scottish Government has invested over £746m to tackle problem alcohol and drug use since 2008. The vast majority of that investment has directly supported local prevention, treatment and recovery services, including for children and young people. In 2016-17, the Scottish Government provided £160,000 to the Corra Foundation Partnership Drugs Initiative (previously Lloyds TSB) to deliver interlinked approaches that will accelerate progress with the recommendations contained in ‘Everyone Has a Story’ with the view of achieving longer-term change in relation to children and young people impacted by recovery and/or drug and alcohol issues.
The Scottish Government has also invested £135,000 per annum in the ‘Choices for Life’ schools-based substance misuse education programme for school children, delivered in partnership with Young Scot and Police Scotland. The Scottish Government will continue to build a universal approach to substance education for all young people, including those most at risk. Circa £110,000 per annum was also provided in support of the ‘Know the Score’ website, which provides factual information and advice about drugs to young people, their families and professionals.
The Scottish Government is aware that families affected by a loved one’s use of substances also need support. Annual funding (£97,000, now £108,000) is provided to Scottish Families Affected by Alcohol and Drugs to support such families.
Scotland was one of the first countries in the world to introduce an ambitious target to reduce smoking prevalence to 5% by 2034 as part of the Scottish Government’s ambition to create a generation of young people who do not want to smoke. The Tobacco Control Strategy – Creating a Tobacco-Free Generation (2013) set out a 5 year plan for action across the key themes of health inequalities, prevention, protection and cessation. The Strategy supported the introduction of standardised packaging within Scotland, the first country within the UK to do so, and education programmes to prevent young people from starting to smoke. In June 2018 this was refreshed as Raising Scotland’s Tobacco-free Generation. This 5 year action plan sets out interventions and policies to help reduce the use of, and associated harms from using, tobacco in Scotland. The action plan builds on the success of the 2013 Strategy which has seen a sustained 50% reduction in children’s exposure to second hand smoke and an ongoing pattern of reduction in smoking rates amongst children in secondary school. Currently less than 2% of 13-year old children and 7% of 15-year old children smoke, compared to an average adult smoking rate of 18%.
Other measures taken forward to support the reduction of smoking within the reporting period include the introduction from 1 October 2017 of a national Register of Tobacco and Nicotine Vapour Product Retailers. A ban on smoking in cars with children came into place in December 2016 through the Smoking Prohibition (Children in Motor Vehicles)(Scotland) Act 2016. The Scottish Government’s Health (Tobacco, Nicotine and Care etc.) (Scotland) Act 2016 includes provisions making it an offence to smoke near buildings on hospital grounds. This will be introduced around hospitals in 2019.
6.19 Palliative and End of Life Care
In 2014, the World Health Assembly, the governing body of the World Health Organisation, passed a resolution requiring all governments to recognise palliative care and to make provision for it in their national health policies. In response, through the implementation of its Strategic Framework for Action on Palliative and End of Life Care (2016-2021), the Scottish Government is continuing to work to improve palliative and end of life care services. The Strategic Framework document committed explicitly to better supporting children and families by promoting the further development of holistic palliative care for the 0-25 year age group, recognising that many of their needs may differ from those of adults. Children’s palliative care is recognised as part of good medical care, and is delivered across primary, secondary and tertiary care. This work is also supported by investment in Children’s Hospices Across Scotland (CHAS) of approximately £30m across the life of this Parliament.
Support for families
6.20 Child Poverty
“Poverty affects children day to day, in terms of practical things like having enough food to eat, a house that is warm and has the necessities of life, but also because worrying about money is stressful for adults. Children see, hear and feel this worry and stress.”
Children’s Parliament, What Kind of Scotland?, 2017, p.7
The Scottish Government is committed to ending child poverty in Scotland, and has taken strong action to make this ambition a reality. Whilst levels of child poverty in Scotland have been consistently lower than across the UK, it is unacceptable that almost 1 in 4 children grow up in poverty.
Following the UK Government abolition of targets to reduce child poverty, Scottish Ministers introduced a Child Poverty Bill. The Bill was unanimously passed by the Scottish Parliament, and is now enacted as the Child Poverty (Scotland) Act 2017. This landmark legislation establishes Scotland as the only part of the UK to have set in statute ambitious income-based targets to be met by 2030-31, with interim targets to be met by 2023-24. This Act provides the impetus for action, underpinned by the requirement to publish regular delivery plans; a robust reporting framework to capture progress and national and local actions; and the establishment of a new statutory body to provide advice and scrutiny on progress: the Poverty and Inequality Commission.
Every Child, Every Chance
The Scottish Government published its first Tackling Child Poverty Delivery Plan due under the Act, entitled ‘Every Child, Every Chance’, in March 2018. This Plan outlines the concrete and ambitious action that the Scottish Government and partners will take in the period until 2022 to make progress against the ambitious child poverty targets. The Plan sets out action from across government portfolios to address the three main drivers of child poverty reduction: income from work and earnings; household costs; and income from social security and benefits in kind. It also sets out action to help improve the lives and outcomes of children currently living in poverty, to break the intergenerational cycle of poverty. Key commitments within the Plan include:
- £12m investment in intensive employment support for parents, to help them enter and progress in the labour market;
- £3.3m investment in a new financial health check service, helping parents maximise their incomes and avoid the poverty premium paid for essential goods and services;
- a new £100 minimum School Clothing Grant, delivered across every local authority in Scotland; and
- working towards introducing an Income Supplement within the lifetime of the Delivery Plan, which will deliver regular, additional financial help to low income families.
All of the actions within the Plan will be developed to maximise impact on levels of child poverty, with a particular focus on the 6 priority groups identified as being at greatest risk, including: lone parents families; families with 3 or more children; households in which a family member is disabled; minority ethnic households; households with a child under 1; and households where the mother is aged under 25 years.
In 2015, the First Minister appointed an Independent Adviser on Poverty and Inequality (Naomi Eisenstadt). The adviser produced two reports during her two year term: the first, ‘Shifting the Curve’, outlining action which could help to drive significant poverty and inequality reductions across society; the second, ‘Review of the Life Chances of Young People’, focused on improving the lives and outcomes of young people from disadvantaged backgrounds. The Scottish Government has committed to implementing recommendations from both reports.
Following on from the success of the Independent Advisor, Scottish Ministers established a Poverty and Inequality Commission in July 2017, chaired by Douglas Hamilton. This body provided valuable advice to Ministers ahead of publication of the first Tackling Child Poverty Delivery Plan and has worked to provide advice and scrutiny across a range of subjects. The Child Poverty (Scotland) Act 2017 commits that this body will move to a statutory footing from 1 July 2019.
Fairer Scotland Action Plan
The Fairer Scotland Action Plan (2016) sets out the Scottish Government’s overarching vision for a fairer and more prosperous Scotland by 2030. It contains 50 concrete actions across 5 high-level ambitions for the period to 2030: a fairer Scotland for all; ending child poverty; a strong start for all young people; fairer working lives; and a thriving third age. A number of these actions, including introducing the Baby Box of essential items, have already been delivered. It also sets out progress in meeting the recommendations of the first of the reports of the Independent Advisor. The Scottish Government has committed to publishing an annual report, setting out progress in relation to the 50 actions. The first of these updates was published in November 2017.
Fairer Scotland Duty
The Fairer Scotland Duty commenced in Scotland from April 2018. The Duty brought into force the ‘socio-economic duty’ within Part 1 of the Equality Act 2010, following public consultation in 2017. The Duty places a legal responsibility on particular public bodies in Scotland to actively consider how they can reduce inequalities of outcome caused by socio-economic disadvantage, when making strategic decisions. Interim Guidance on the Duty was published by Scottish Ministers in March 2018. The Equality and Human Rights Commission (EHRC) is the regulator for the Fairer Scotland Duty and will be closely involved with monitoring and the development of best practice for the Duty, particularly in the first 3 years; the implementation phase.
Access to Sanitary Products
To address the issue of lack of access to sanitary products, from August 2018 the Scottish Government delivered on its PfG 2017-18 commitment and became the first national government to introduce access to these products for up to 395,000 students attending schools, colleges and universities in Scotland, providing £5.2m of funding this year. The PfG 2018-19 builds on both the earlier PfG commitment and the announcement in May 2018 that, following the Aberdeen pilot, access to free sanitary products for those on low incomes will be expanded across large areas of the country via FareShare and its network of community partners.
In 2019, the Scottish Government plans to go even further, working with a range of public and third sector organisations to increase the number and range of places in communities where these products are available for those who need them, and encouraging the private sector to take similar action.
Scottish Labour Market Strategy
In Scotland today nearly half of all adults and 70% of all children who live in poverty are in households where at least one person is working. This statistic highlights the need for work in Scotland to become the route out of poverty it traditionally has been. The Scottish Government considers that paying employees the real Living Wage, rather than the minimum wage, not only makes sense from a business perspective but is an important step to tackling in-work poverty.
The Scottish Government’s Labour Market Strategy (2016) establishes a framework for a strong labour market that drives inclusive, sustainable economic growth, characterised by growing, competitive businesses, high employment, a skilled population capable of meeting the needs of employers, and where fair work is central to improving the lives of individuals and their families. Having reached the target of having 1,000 accredited Living Wage employers, the Scottish Government is committed to lifting at least 25,000 more people onto the real Living Wage. Over the next 3 years, the Scottish Government will work with the Poverty Alliance to build a ‘Living Wage Nation’, boosting the wages of those on low pay and supporting inclusive growth. There will also be a focus on the hospitality and tourism sectors, where there are many low paid jobs. These sectors are dominated by women workers, the majority of whom work part-time.
The Scottish Government’s joint strategy, focusing on a place-based approach and low pay industries, will greatly help the coordinated approach needed across government to ensure that, for those who are able to work, paid employment offers the best and most sustainable route out of poverty. The Scottish Government will adopt a new default position – termed ‘Fair Work First’ – that will see criteria, including the living wage, extended to more contracts and government support grants.
6.21 Support for Lower Income Families
The Scottish Government has taken a number of other measures throughout the reporting period to further support Scotland’s low income families and to reduce inequalities. Of particular note is the commitment to almost doubling the funded entitlement to early learning and childcare from 600 to 1140 hours per year from August 2020 for all 3 and 4 year olds and for eligible 2 year olds. This is discussed further at section 7.9.
In May 2018, Scottish Ministers announced that an estimated 120,000 children would benefit from a new £100 national minimum school clothing grant as a result of a partnership between the Scottish Government and local government. The scheme, with estimated annual costs expected to reach £12m, ensures for the first time that all eligible families, regardless of their local authority area, will have access to the same minimum level of financial support for school clothing. The grant will be reviewed after 2 years to ensure that the amount available remains in line with the cost of living.
Since January 2015, free school lunches have been available to all pupils in primaries 1 to 3 at all publicly funded schools in Scotland. This policy helps save families an average of £380 per child per year, helps children develop healthy eating habits, and educates them about leading a healthy lifestyle. In 2018-19, the Scottish Government provided local authorities with £53.9m to deliver on this commitment. After primary 3, children are still entitled to free school meals where their parents (or guardians) are in receipt of specific qualifying benefits. Older pupils who receive any of those benefits in their own right can also claim free school lunches.
Under the provisions of the Education (Scotland) Act 2016, education authorities have the flexibility to provide free school meals to pupils who are not eligible under the regular national eligibility criteria where they feel it is appropriate to do so. This provision allows for free school meals to be given to families who experience financial hardship due to exceptional circumstances. This may include families who have no recourse to public funds as a result of their immigration status, or those who are awaiting their first Universal Credit monthly award notice.
Schools are required by statute to promote school lunches and, in particular, free school lunches and the Scottish Government expects all local authorities to undertake measures aimed at maximising the uptake of free school lunches among eligible people.
Food Insecurity During School Holidays (Holiday Hunger)
Local authorities already have flexibility to provide meals and activities for children outwith term times, for example holiday lunch clubs and other activities. The provision of these services during holiday periods has been supported by the Scottish Government’s £750m Attainment Scotland Fund. In addition, the Scottish Government’s Empowering Communities Fund and Fair Food Transformation Fund are also supporting community initiatives that help children and families access food throughout the year.
The Scottish Government is determined to do more to tackle the issue of food insecurity during the school holidays and will invest £2m in 2019-20 to help accelerate action. The Scottish Government will work with COSLA, local authorities, the third sector and other stakeholders to build momentum, trial new approaches, and develop a clear plan of action for the future.
The Scottish Government believes that no one should experience food insecurity in a country as prosperous as Scotland, and established an Independent Working Group on Food Poverty in 2015 to consider the issues and advise on how they can be addressed. One of the Group’s recommendations was that the Scottish Government should routinely monitor household food insecurity.
The Scottish Government accepted and actioned this recommendation by adding 3 priority questions from the United Nations Food Insecurity Experience Scale into the Scottish Health Survey in 2017. Data was published on 25 September 2018, finding that 8% of people are worried about running out of food due to a lack of money or other resources. Also, 7% of people said they ate less than they should, and 4% said they had run out of food due to a lack of money or resources. The household types most likely to have worried they would run out of food were single parents, and adults aged 16-64 living alone. This baseline information will allow further analysis of food insecurity and the impact of policy and practice in tackling it. In addition, the Scottish Government has integrated food insecurity data as an indicator in the National Performance Framework for outcomes on human rights and poverty.
The Scottish Government published its full response to the Independent Working Group’s report and recommendations in November 2016, providing the framework for tackling food insecurity nationally, which the Scottish Government is taking forward with key partners. Notably, the Scottish Government committed to explore with stakeholders whether the right to food could be enshrined within Scots Law. The First Minister’s Advisory Group on Human Rights Leadership published its recommendations in December 2018 on how Scotland can go further, and do more in giving effect to its international human rights obligations. The Scottish Government will also be consulting on legislation to underpin the work already being progressed on the Good Food Nation ambitions before the end of this year.
From 2017-18, Scottish Ministers established the Fair Food Transformation Fund and committed £1m in each year of the Parliament to this. The Fund was increased to £1.5m in 2018-19, and £3.5m in 2019-20. The Fund currently supports 34 community-based projects across Scotland, including 13 food banks, to deliver dignified responses to food insecurity and help to tackle the causes. £2m will be focused in 2019-20 on supporting children and families during school holiday periods.
This government has always prioritised tackling fuel poverty, ensuring that everyone in Scotland lives in a warm home that is affordable to heat. Following a public consultation, the Fuel Poverty (Target, Definition and Strategy) (Scotland) Bill was introduced to Parliament on 26 June 2018. The Bill: enshrines into legislation a target that, by 2040, no more than 5% of households will be in fuel poverty; sets out a new definition of fuel poverty that aligns more closely with relative income poverty to focus support on those who need it most; and mandates the production of a new, long-term fuel poverty strategy. It also places a duty on the Scottish Ministers to publish and lay before Parliament a report setting out the steps taken towards the target, the progress made in this regard, and the steps to be taken towards the target in the next reporting period. The reporting periods will be every 5 years, beginning on the day on which the fuel poverty strategy is published.
Alongside the Bill, Scottish Ministers published a draft Fuel Poverty Strategy, which sets out more information on the actions the Scottish Government is taking to support households in fuel poverty. The Scottish Government will work with communities and stakeholders to progress the Draft Strategy and will publish a final Strategy within a year of Section 3 of the Act coming into force.
The Draft Strategy builds on action that the Scottish Government is already taking to ensure those worst affected by fuel poverty – no matter where in Scotland they live – get the support they need. Home Energy Scotland – a network of local and impartial expert advice centres providing support on a variety of topics including energy saving measures – already prioritises engagement with families with children, and will continue to engage amongst a broader range of stakeholders and organisations, in order to ensure that priority groups with low incomes and with children are aware of the help and support available to them. In order to help families living in poverty immediately, the Scottish Government will work to increase their uptake of the national fuel poverty scheme, Warmer Homes Scotland.
The Draft Strategy further proposes to eradicate poor energy performance as a driver of fuel poverty. Energy efficiency has been designated a national infrastructure priority. The cornerstone of this is Energy Efficient Scotland which Scottish Ministers launched on 2 May 2018. Energy Efficient Scotland will, over the next 20 years, transform Scotland’s buildings, making them warmer, greener and more efficient, and will put in place a framework of standards making it the norm to invest in energy efficiency. By 2021, the Scottish Government will have allocated over £1 billion since 2009 on tackling fuel poverty and improving energy efficiency.
6.22 Social Security
The Scotland Act 2016 devolved new social security powers to Scotland. Section 1 of the Social Security (Scotland) Act 2018 (2018 Act) sets out 8 core principles in the Scottish social security system’s founding legislation. These principles, which will define all aspects of the design, development and implementation of this new system, include the principles that social security is a human right and is essential to the realisation of other human rights and that respect for the dignity of individuals is to be at the heart of the Scottish social security system. The 2018 Act also proposes a statutory requirement on Ministers to produce a publicly accessible charter that reflects the key principles and communicates in clear terms what people are entitled to expect from the new system, and how it will be delivered in practice.
The charter is being co-designed with people who have lived experience of social security and these people have the lead role in deciding what the charter should contain. A core group of around 30 people has been recruited to do this. A separate advisory stakeholder group of more than 27 organisations has been set up to provide feedback and advice to the core group for consideration. The charter and subsequent reviews must be approved by Parliament. Ministers will have a duty to report on progress against commitments made in the charter.
An independent expert scrutiny body, the Scottish Commission on Social Security, will also be established and its functions will include submitting a report to Ministers and Parliament on the extent to which the expectations set out in the charter are being fulfilled, including recommendations for improvement if they are not. The Commission will also have a legal duty to have regard to any relevant international human rights instruments in the exercise of its functions.
The Scottish Government considers that its actions and commitments so far demonstrate that a rights-based approach is at the core of the proposed system. For example, through the public campaigns to raise public awareness of entitlement, with the ultimate aim of improving take-up; commitments to increase payment levels and widen eligibility in relation to Carer’s Allowance and the new Best Start grant, and the recruitment of over 2,400 people with direct experience of the current system to co-design a new and better social security model for Scotland. The Scottish Government is confident that it is building a system that will come to be regarded as an international exemplar of person centred public service founded on dignity, respect and human rights. This will have a direct and meaningful impact on children who are often negatively impacted by the stigma, anxiety and lack of support experienced by their parent/primary carers.
Best Start Grants
Power to create assistance with maternity expenses is devolved in the Scotland Act 2016, as is the power to create new benefits. Scottish Ministers have used powers set out in the Social Security (Scotland) Act 2018 to introduce a more comprehensive benefit than the DWP maternity expense benefit, the Sure Start Maternity Grant (SSMG). The Best Start Grant (BSG) will help support families with young children, both in and out of work, who are feeling the impact of UK Government welfare reform. For those who meet its eligibility criteria/qualifying conditions, BSG will provide a payment for a first child of £600 (an increase on the SSMG payment of £500). The Scottish Government will introduce £300 birth payments for second and subsequent children and two new grants of £250, per child, at key transition points in their early years, none of which are available under SSMG.
The BSG forms part of a programme of measures targeted at children’s early years with the aim of tackling inequality, supporting parents, and improving health outcomes and raising attainment. The CRWIA process identified that there is scope for the BSG to have a positive impact on children’s rights, helping to give children the best start in life.
The Scottish Government will make the first Best Start Pregnancy and Baby Grant payments before Christmas 2018. Payments of the Early Learning and School Age Grants will follow by summer 2019.
Scottish Welfare Fund and Discretionary Housing Payments
The Scottish Welfare Fund provides a safety net for vulnerable people on low incomes through the provision of Community Care Grants and Crisis Grants. From 1 April 2013 to 30 June 2018, 306,305 individual households in Scotland, including 101,207 families with children, have been helped with awards totalling £173m.
The Scottish Government continues to mitigate the bedroom tax through Discretionary Housing Payments, with a budget of £51m specifically allocated for this purpose in the
2018-19 budget, alongside £10.9m for other households affected by UK Government welfare reform or who require additional support with their housing costs.
The Scottish Government is determined to build on its record of reducing homelessness and tackling rough sleeping. In taking this forward, it has set a clear national objective to eradicate rough sleeping, recognising that it requires more than just the provision of housing and that every individual will have their own unique needs and challenges.
The Scottish Government has focused on the holistic and person-centred Housing Options approach to homelessness prevention, which features early intervention and explores all possible tenure options including, council housing, housing association housing and the private rented sector. Advice can also cover personal circumstances which may not necessarily be housing related, such as debt advice, mediation and addressing mental health issues. The Scottish Government has continued to fund 5 regional local authority led Housing Options Hubs across Scotland and also published Housing Options Guidance in 2016. The long-term trend shows a decrease in applications since 2008. That is a 39% reduction from 57,672 in 2008-09 to 34,972 in 2017-18. The slight 1% rise in applications in 2017-18 follows an 8 year decline.
In October 2017, Scottish Ministers set up the Homelessness and Rough Sleeping Action Group (HARSAG) to recommend the actions and solutions needed to eradicate rough sleeping, transform the use of temporary accommodation and end homelessness in Scotland. On 27 June 2018, Scottish Ministers accepted all 70 recommendations from the Action Group in principle, which covered addressing the wider risk factors for homelessness including poverty, social security and migration policy and early intervention with high risk groups, including for example young people with experience of the care system. These recommendations reach across a number of areas of government policy, well beyond housing. The Scottish Government is supporting the implementation of these recommendations with a £50m Ending Homelessness Together Fund to drive sustainable and lasting change. The Scottish Government published the Ending Homelessness Together: High Level Action Plan in November 2018, setting out how the recommendations will be taken forward.
To underline the commitment to making these changes, the Scottish Government has allocated up to £23.5m from the Ending Homelessness Together Fund and from the health portfolio to support the Action Group’s recommendation to adopt rapid rehousing and Housing First nationally so that local authorities and partners can support people into settled accommodation first and then help them with their longer term needs. This will minimise the time anyone spends in temporary accommodation.
Good quality, warm and affordable housing is vital to ensuring a Scotland that is fair for this and future generations. Since 2012, all those assessed by local authorities as being homeless, through no fault of their own, are entitled to settled accommodation. Anyone threatened with, or experiencing homelessness, is legally entitled to a minimum of temporary accommodation, advice and assistance from their local authority. Temporary accommodation is an important part of Scotland’s strong homelessness legislation but time in unsuitable temporary accommodation should be as short as possible, especially for households with children or where there is a pregnancy. In 2017, Scottish Ministers legislated to introduce a cap of one week for families and pregnant women living in B&B accommodation.
The Scottish Government wants to reduce the need for temporary accommodation and ensure that, where it is required, the people who live there have the support they need to enable them to move to settled accommodation. The Scottish Government is committed to developing a new standards framework to ensure that temporary accommodation is of good quality and serves the needs of its residents by assisting them to achieve positive outcomes.
6.24 Affordable Housing
“Children see the need for every child and family to have the home they need – a permanent, stable place of their own, with space for everyone and access to places to play.”
Children’s Parliament, What Kind of Scotland?, 2017, p.32
The Scottish Government exceeded its previous 30,000 affordable homes target by more than 10%. To end March 2016, 33,490 affordable homes were delivered, including 22,523 for social rent.
Over the lifetime of this Parliament, the Scottish Government is investing over £3 billion to deliver at least 50,000 affordable homes, 35,000 of which will be for social rent. Over £756m is available in 2018-19 and from this, over £568m has been allocated to council areas across Scotland. The increases will continue over the coming years, rising to £591m in 2019-20 and £630m in 2020-21. This brings the overall funding allocated to councils for affordable housing to £1.79 billion over the 3 years to end March 2021. 81% of the Affordable Housing Supply Programme grant funding in 2018-19 – almost £615m – is capital funding, primarily for social housing. This grant funding will enable councils and housing associations to maintain the momentum needed to increase the pace of delivery.
Support for Communities
6.25 Planning and Architecture
Following an Independent Planning Review, the Scottish Government is committed to ensure wider engagement across all areas of society in the future development of local areas, including with children and young people. In support of the 2017 consultation paper,
Places, People and Planning, the Scottish Government funded Young Scot to undertake an online survey of children and young people to support the policy development.
The Planning (Scotland) Bill was introduced into Parliament in December 2017. The Scottish Government undertook a CRWIA of the wider policy intention to promote enhanced engagement in the planning system through the review of planning. This assessment found that the Bill’s provisions for the introduction of Local Place Plans would have a positive impact on the participation of children and young people. It also found that the provisions for enhanced engagement, including the requirement to use methods that will secure the engagement of children and young people in the process, will have a positive and direct impact.
During stage 2 of the Bill, the Government introduced an amendment requiring planning authorities to seek and have regard to the views of the public at large when preparing their evidence reports and, specifically, to report on how they have done so and how the views expressed by children and young people have been taken into account. These were agreed by the Committee, along with other non-Government amendments requiring planning authorities to facilitate the participation of children and young people in the preparation of the local development plan, and to produce a ‘play sufficiency assessment’ for the local development plan evidence report. Stage 3 of the Bill is expected to take place early in 2019.
The Scottish Government will commence a review of the National Planning Framework following the Planning Bill’s passage through Parliament. This will provide an opportunity to demonstrate how children and young people can have a full and meaningful say in the future of their places. The accompanying participation statement will set out methods which actively engage children and young people so they are inspired and involved in shaping Scotland’s future development to 2050.
The Scottish Government has also provided funding to support community engagement. This has included the development of a Place Standard App, focused on supporting young people to engage with their environment. The Scottish Government is promoting the use of the Place Standard tool with children and young people as a method of realising children’s rights in planning and is developing a child-friendly version of this tool to further support the participation of younger children.
Support has also been provided to PAS, (formerly Planning Aid for Scotland) to work with communities and interest groups across Scotland, including children and young people, to build their capacity to participate and engage in the planning process. The Scottish Government has also provided substantial grant funding to support the Greenspace Scotland ‘Young Placechangers’ 3 year programme. The £90,000 ‘Ideas Fund’ was launched in October 2018 to support the delivery of practical placemaking ideas, developed by young people to enhance their communities.
Building and Fire Safety
Following the Grenfell tragedy in June 2017, the Scottish Government acted quickly, setting up a Ministerial Working Group to review Scotland’s building and fire safety regulatory frameworks in order to help ensure that people are safe in Scotland’s buildings, make any recommendations for improvement as required, and add to stringent safety regulations already in place if necessary. While the initial focus of the Group has been on high rise domestic buildings, the Group are also looking at other buildings including housing, the NHS estate, schools and prisons. A number of actions agreed by the Ministerial Working Group will be implemented throughout 2019.
“Children are worried about the future of children, animal and plant species in Scotland and around the world if we fail to address climate change.”
Children’s Parliament, What Kind of Scotland?, 2017, p.33
Climate change is one of the defining global challenges of our time and Scotland is internationally recognised as a world leader in tackling it. The Scottish Government has already succeeded in reducing greenhouse gas emissions by 49% and has introduced a Bill to Parliament which will make Scotland’s existing climate legislation even tougher.
Achieving a reduction in air pollution is an important aspect of the Scottish Government’s drive to creating a cleaner, greener and healthier Scotland for current and future generations. In 2015, the Scottish Government published Cleaner Air for Scotland – The Road to a Healthier Future, Scotland’s first distinct air quality strategy, which set out a comprehensive series of actions intended to deliver further reductions in air pollution. The strategy includes a particular focus on reducing health inequalities through better air quality, especially in relation to vulnerable groups in society including children and young people. It also contains a commitment for Scotland to be fully compliant with EU air quality legislation by 2020. The PfG 2018-19 announced that a comprehensive review of Cleaner Air for Scotland will be undertaken, to ensure that the strategy remains on track to achieve these targets.
The PfG 2016-17 committed to establishing Scotland’s first Low Emission Zone (LEZ) by the end of 2018. In October 2017, the First Minister confirmed the location of this first LEZ as Glasgow. The PfG 2017-18 committed to establishing further LEZs in Aberdeen, Dundee and Edinburgh by 2020, with further LEZs by 2023 in all other places with local Air Quality Management Areas, where the evidence supports introduction.
The Scottish Government continues to take steps to hear the views of children and young people and to raise awareness of air quality and pollution. For example, in 2017, the first National Clean Air Day was staged, which involved wide engagement with schools and members of the public. The second Clean Air Day in 2018 achieved further significant progress in public engagement. The Scottish Government also funds and supports air quality based educational resources for young people and teachers.